Cardiology Dr Osama Mahmoud

~Portal hypertensionr--.,...--:

Oes?hageal varices.

1-----+- Ascites,

2..l~enal~ein 1111·0111bosis

o Common in membranous

GN.

o Dehydration

o Blood disease C/P ELoin pain and tenderness.

worsening of kidney function?

3.. I"C tlU·Ol11bosis

Proteinuria.

Cause

0 Typhoid.

f} Behcet's

disease.

C/P

*

Edema of both lower limbs.

* Ascites.

* Collaterals on the abdominal

wall.

4.. S"C Th'·0111bosis

* Constrictive pericarditis. Mediastinal

Cause

mass.

*

• Pain, tenderness along the course of axillary vein.

PULMONARY EMBOLI!iM

I

~ C/p

J.~

S111a11 sized embolism

• No symptoms, but cough, dyspnea or chest discomfort may occur.

Recurrent embolization with obliteration of >2/3 of pulmonary vascular bed .

•

.

Thromboembolic pulmonary hypertension

Right

sided failure

(cor pulmotale) i.e. subacute cor pulmonale.

~ c/p:B- Moderatesized em.boli(Pujmonary

Cardi,,4ogy

Infarctfon)

1. Cough

2., Blood tinged sputum

3. Chest Pain

4. Dyspnea

5. Fever.

••••••••~IPaI •••

a -

Pleural

rub.

b- Crepitations

may present

over the involved area.

.

c-

Blood

stained effusion

may developed

(exudative

effusion) .

•

•

•

•

•••••••.•

.............................

.........

> EC6

.,

Normal except for sinus tachycardia, AF may occur.

.,

Right ventricular strain may occur (inverted T in VI, V2)

.,

Right

axis deviation .

.,

Right

BBB.

I Ventilation Scan

Penusion

Scan

Patient

inspires (Xenon)

IV injection of radioactive

gas with radioactive material

material

(Tc)

We detect the•distribution

Lung uptake occurs•

by pulmonary arteries,

of the

radioactive

this can be detected

by gamma camera

material by gamma camera

•

within

lung tissue, this 1i!!1% ~

'\1 This reflects

pulmonary

reflects

ventilation.

vascularity.

Normal ventilation scan + abnormal

perfusion scan highly suggestive for

pulmonary embolism.

lmonary embolism obstructing> 50 % of pulmonary

vasculature .

...•..-

1. Chest Pain

(similar to anginal pain) due to:

.

.

•

Hypotension

or shock (J.cop n

•

Hypoxia.

~

Angmal pam

Treatment

of pulmonary

embolism & D.V.T

I. P,ophylactic

measures:

o Avoid prolonged post operative recumbency

specially in pelvic surgery (e.g

hysterectomy, hip surgery, prostatectomy).

@ In risky patients subjected to surgery

give:

mini dose heparin or low molecular

weight

heparin (post operative).

•

Streptokinase.

• Urokinase.

• Recombinant tissue plasminogen activator.

Value

~

Relief the obstruction of the pulmonary vasculature.

~

Improvement

of right ventricular efficiency.

~

Correction of the hemodynamic instability.

Give 5000 - 10.000 units IV as a loading

dose.

Then 1000 units / hr IV infusion drip.

Heparin infusion is the best ~ Low

incidence of haemorrhage.

Why?

1.Maintained

therapeutic level all over

the day.

Other methods of heparin therapy:

'i 5000 - 7500 units

IV /6hrs

'i 10,000 units se / 8hrs.

Duration of heparin therapy ~

7-10 days or till clinical improvement.

IWarfarin

I

2.5-

7.5 mg/d.

The dose is adjusted according

to PT to be (1.5 - 2) of the control value

or to reach an INR value (2-3.5) according

to the need .

.•.•.•.....

••......

••........

•.....

••.....

. •••••. ....•••

.............

•

........

•......

•..........

•.•••.•

..

The insertion

of filter into Ive can be done if the anticoagulant

or

fibrinolytic

therapy

is contraindicated

or fails to inhibite

thromboembolism.

So high risk patients with contraindications

of anticoagulant

therapy

can be

treated by insertion

of a filter in the Ive above

the level of the renal

veins to .

•••

•

prevent.embolisation,

••.•

•••.•.•..•••••

•

:

•.................

•..•......

~...

•• •

Pulmd~~jf~~bolism

should~.~ su~~~ctedin

patient with new onset-of

unexplainedqough,

dyspnea,

orhYJ?erventilation,

chest pain, haemoptysis,

AF, Of with

signs ..of P++ if no othy;t':cause can be found

qJ q

I q

~:t~~~~~a~issects

~-~-

....- _---'7

~w~

/

through

the media

5ij I~

leading

to

narrowing of

branche

of aorta

Types of dissecting

aortic aneurysm:

'i Type I

---+ Proximal

ascending aorta to descending.

'iType II ---+ Confined

to ascending aorta.

'i Type III --+ Descending aorta and distally.

CO 1\1IiEI\I

IT AL HEART DI!iEA!iE

i

(0.8 % of live births)

•• \~hen ~Otl

stlsl,ect

congenital heart 'lisease?

1 -Age < 5 years.

2 - Hypertension

in a child.

3 -Positive prenatal history.

4 - Associated congenital anomalies.

5 -Cyanosis since birth.

6 - Negative

history of rheumatic fever.

7 - Thrill over the base (AS-PS) or left parasternal

(VSD)

C~IU e~\s~

'r:la c'"ifr!O\r.JS~l·\

~

-~~~

~=:I_=~:lSI=:I

~IJ

1- Genetic

abnormalities e.g congenital heart block, ASD.

2- Irradiation.

3- Maternal rubella (PDA, Pulmonary stenosis)

4- Premature

infants.

5- Chromosomal abnormalities e.g.: .:. Down's

syndromc-e-VSl) .

•:. Turner's

syndrome-scoarctation

of aorta

6- Maternal alcohol abuse (septal defects).

YI=:I_a

ri

Cll

~~~~e~s~ii*.Hiim'~1~SI=:I=(f)\D

• Cianotic

• A ",~anotic

• l'olentialli

cStanotic

e Fallot's

tetralogy

e Coarctation of aorta.

e VSD.

e Fallot's

triology

e PSAS.

e PDA.

e Dextrocardia

e ASD.

1.

X-ray

• Coeur

en sabot heart (Rt Y++)

2.

ECG

• Right

ventricular

hypertrophy.

3.

Echocardiography

4.

Catheter

• Measures

pressure-ohigh

right ventricular pressure.

• Measures

O2 ~

Low O2

of aorta.

Innominante

artery

Shunt between left subclavian

and left pulmonary artery

Right ~

Right common carotid

VAlUE:

= Improvement

of cyanosis and general condition.

= Improvement

of the vasculature of the attenuated

pulmonary vessels.

[F-TRIOLOGY )

[F-TETRALOGY )

._---

ASH +PS +Huge RT.

'i Mild RtV+ +.

'i Huge right V.

Neck veins is not congested.

'i<Congestedneckveins.

Cyanosis Since birth.

'iCyanosis is delayed

Single loud S2

'i S2 is weak with

wide splitting

Huge"Rt.V

L

* The reversed

shunt

cyanosis,

this is not

Eisenmenger's

synd1;ptr1e

because

there is no·P+·+

F. Pentalogy

(F4+ASD).